Becoming Baby-Friendly: Overcoming the Issue of Accepting Free Formula

Anne Merewood, MA, IBCLC, and Barbara L. Philipp, MD, IBCLC

J Hum Lact 16(4), 2000

Baby-Friendly is a World Health Organization/UNICEF international designation that is awarded to hospitals or birthing sites that meet certain criteria related to supporting and promoting breastfeeding. Those criteria are called the Ten Steps to Successful Breastfeeding (see Table 1). This article focuses on Step 6 of the Ten Steps: “Give newborn infants no food or drink other than breast milk, unless medically indicated.” To comply fully with the Baby-Friendly Hospital Initiative, an institution must pay fair market price for all formula and infantfeeding supplies that it uses, and it cannot accept free or heavily discounted formula and supplies. In our view, it is not surprising that many hospitals have major problems achieving this step to being designated Baby-Friendly. When a hospital is already receiving free formula, breastfeeding advocates are put in the difficult position of persuading administrators to reverse a trend and pay for a product that is usually free.

The majority of US hospitals do not purchase infant formula and related products such as nipples, glucose water, and pacifiers. In addition, many institutions also accept free discharge bags, supplies, literature, videos, and other gifts from formula companies, such as lunches, pens, calendars, and trips (Marsha Walker, personal communication, January 2000). Products such as hospital discharge bags that contain formula samples have been shown to adversely affect breastfeeding initiation and duration rates.2,3 After being designated a babyfriendly hospital in December 1999, Boston Medical Center (BMC) received many calls and e-mails on the topic of paying for formula. During BMC’s journey toward Baby-Friendly designation, paying for formula was a key issue, and information on the topic was hard to find. This article addresses the gray area surrounding paying for formula and offers practical solutions for other hospitals interested in the Baby-Friendly certification process.

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